We sought to determine differences in efficacy and tolerability between different doses of selective serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder (OCD) using meta-analysis. We identified 9 studies involving 2268 subjects that were randomized, double-blind placebo-controlled clinical trials that compared multiple, fixed-doses of selective serotonin reuptake inhibitors (SSRIs) to each other and to placebo in the treatment of adults with OCD. Change in Y-BOCS score, proportion of treatment responders, and dropouts (all-cause and due to side-effects) were determined for each included study. Weighted mean difference was used to examine mean change in Y-BOCS score. Pooled absolute risk difference was used to examine dichotomous outcomes. Meta-analysis was performed using a fixed effects model in RevMan 4.2.8. We found that compared with either low or medium doses, higher doses of SSRIs were associated with improved treatment efficacy, using either Y-BOCS score or proportion of treatment responders as an outcome. Dose of SSRIs was not associated with the number of all-cause dropouts. Higher doses of SSRIs were associated with significantly higher proportion of dropouts due to side-effects. These results suggests that higher doses of SSRIs are associated with greater efficacy in the treatment of OCD. This SSRI efficacy pattern stands in contrast to other psychiatric disorders like Major Depressive Disorder. This greater treatment efficacy is somewhat counterbalanced by the greater side-effect burden with higher doses of SSRIs. At present, there are insufficient data to generalize these findings to children or adolescents with OCD.

译文

我们试图使用荟萃分析来确定不同剂量的选择性5-羟色胺再摄取抑制剂在强迫症 (OCD) 治疗中的疗效和耐受性差异。我们确定了9项涉及2268名受试者的研究,这些研究是随机,双盲安慰剂对照临床试验,比较了多个固定剂量的选择性5-羟色胺再摄取抑制剂 (SSRIs) 彼此以及安慰剂治疗成人强迫症。对于每个纳入的研究,确定了y-bocs评分的变化,治疗应答者的比例和辍学 (所有原因和副作用)。加权平均差用于检查y-bocs评分的平均变化。合并的绝对风险差异用于检查二分结局。使用RevMan 4.2.8中的固定效应模型进行荟萃分析。我们发现,与低剂量或中剂量相比,使用y-bocs评分或治疗应答者比例作为结果,较高剂量的SSRIs与改善的治疗效果相关。SSRIs的剂量与全因辍学的数量无关。较高剂量的ssri与由于副作用而导致的辍学率明显较高。这些结果表明,较高剂量的SSRIs与OCD治疗的疗效相关。这种SSRI功效模式与其他精神疾病 (例如重度抑郁症) 形成鲜明对比。这种更大的治疗效果在某种程度上被更高剂量的SSRIs带来的更大的副作用负担所抵消。目前,没有足够的数据将这些发现推广到患有强迫症的儿童或青少年。

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